Podcast: A Therapeutic Primer for Primary Care Physicians: The Value of Talk - Part 1: Introduction

Lieberman Podcast Part One

Primary care physicians are often the first to see patients with mental health problems and they provide 70% of mental health care to patients. They also write a majority of the prescriptions for antidepressant and antianxiety medications in the United States. This is understandable in light of the fact that physical and mental ailments are often comorbid. But, there may be more to treating a patient who presents with depression than prescribing a pill.

We’ve invited Dr Joseph A. Lieberman to record a series of informational podcasts based on a book he has coauthored, The Fifteen Minute Hour: Therapeutic Talk in Primary Care. Part 1 is an introduction familiarizing physicians with why talking to patients is important and the concepts and tools that can be used to facilitate discussion.

In part 2, Dr Lieberman will discuss how physicians can manage difficult patients, whether they are a chronic complainer, substance abuser, or hypochondriac. He explains how you can see these patients as a learning experience rather than a challenge to be rid of as quickly as possible.

Anxiety, major depression, and bipolar disorder will be discussed in part 3. In this section, Dr Lieberman presents some simple tools that can be used to help diagnose a disorder. The focus of the last podcast is 2-pronged: how to talk to your patients, and how to take care of yourself (part 4).

To read a Book Review of Dr Lieberman's book The Fifteen Minute Hour: Therapeutic Talk in Primary Careclick here.

Part 1: Introduction

In this first podcast, Dr Lieberman reviews the essentials used in teaching primary care clinicians the art of therapeutic talk. Listening to Dr Lieberman’s podcast will help you recognize and treat mental health problems that you may encounter in your patients. He provides several techniques that you will probably find valuable in your daily practice.

SOAP: An early technique developed by Dr Larry Weed in the 1970s.
S  Subjective
O  Objective
A  Assessment
P  Plan

BATHE: A technique to elicit information from patients.
B  Background: what is going on in your life?
A  Affect: how do you feel about that?
T  Trouble: what troubles you the most?
H  Handling: How are you handling that?
E  Empathy: That must be very difficult

Two-question screener to determine whether patient is depressed:
1. In the past month, have you been feeling down, blue, depressed, or hopeless?
2. In the past month, have you lost interest in doing things that you formerly found pleasurable?

Depression ScaleS   Sleep or sexual desire increased or decreased
I    Interest or pleasure in activities decreased
G  Guilt, worthlessness or hopelessness
E  Energy decreased; fatigued
C  Concentration difficulties
A  Appetite changes
P  Psychomotor agitation or retardation
S  Suicidal ideation, plan, or attempt

Anxiety ScaleS Somatic symptoms
W Worries
I   Irritability
C Concentration
K Keyed up or on edge
I Initial insomnia
R Relaxation difficulties

Other useful tools
• Patient Health Questionnaire (PHQ9)
• Generalized Anxiety Questionnaire (GAD7)
• Mood Disorder Questionnaire (MDQ)
• Fatigue Severity Scale (FSS)
• Epworth Sleepiness Scale (ESS)